SB 1041 Summary

• Amends the Illinois Public Aid Code to establish managed care protections for Medicaid, requiring MCOs to pay non-contracted emergency service providers at Illinois Medicaid fee-for-service rates including all applicable adjustments.

• Mandates MCOs cover post-stabilization services in specified circumstances, including when MCO authorization is given, services are provided within one hour of request, MCO cannot be contacted, or treating providers cannot reach agreement with affiliated providers.

• Prohibits MCOs from requiring prior approval for emergency services, conditioning coverage on provider notification within 10 days, or overriding attending physician determinations of patient stabilization for discharge or transfer.

• Requires the Department to ensure adequate provider networks, maintain a provider complaint portal for dispute resolution with defined timelines, and publish quarterly MCO performance metrics covering claims payment, prior authorizations, grievances, credentialing, and customer service.

• Establishes timely claim payment requirements of 30 days with penalties equal to insurance code interest rates for late payment, expedited provider payment schedules, and annual medical loss ratio reports for each MCO.